PREVENTION AND TEACHING. Emphasize to the patient the need to quit smoking or using tobacco and limit caffeine intake. Recommend maintaining a warm environmental temperature of about 21°C (70°F) to prevent chilling. Teach the patient to avoid elevating the legs or using the knee Gatch on the bed, to keep legs in a slightly dependent position for periods during the day, to avoid crossing the legs at the knees or ankles, and to wear support stockings. Explain why the patient needs to avoid pressure on the affected extremity and vigorous massage, and recommend the use of padding for ischemic areas.

Stress the importance of regular aerobic exercise to the patient. Explain that activity improves circulation through muscle contraction and relaxation. Exercise also stimulates collateral circulation that increases blood flow to the ischemic area. Recommend 30 to 40 minutes of activity with warm-up and cool-down activities on alternate days. Also suggest walking at a slow pace and performing ankle rotations, ankle pumps, and knee extensions daily. Recommend Buerger-Allen exercises, if indicated. If intermittent claudication is present, stress to the patient the importance of allowing adequate time for rest between exercise and of monitoring one's tolerance for exercise.

Provide good skin care, and teach the patient to monitor and protect the skin. Recommend the use of moisturizing lotion for dry areas, and demonstrate meticulous foot care. Advise the patient to wear cotton socks and comfortable, protective shoes at all times and to change socks daily. Advise the patient to seek professional advice for thickened or deformed nails, blisters, corns, and calluses. Stress the importance of avoiding the application of direct heat to the skin. The patient also needs to know that arterial disorders are usually chronic. Medical follow-up is necessary at the onset of skin breakdown such as abrasions, lesions, or ulcerations to prevent advanced disease with necrosis.

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